MANUAL MINORS
Psoriatic arthritis is a chronic inflammatory disease that affects the joints and is associated with psoriasis, a skin condition characterised by scaly, erythematous plaques. Psoriatic arthritis can affect both peripheral joints and the spine, presenting with pain, swelling, joint stiffness, and in some cases, dactylitis (“sausage fingers”) and enthesitis (inflammation at tendon insertion sites). The severity and pattern of the disease vary, ranging from mild to destructive arthritis.
Diagnosis
Diagnosis is based on the presence of inflammatory joint symptoms along with a history of cutaneous psoriasis or a family history of psoriasis. Clinically, asymmetric arthritis, dactylitis, enthesitis, and nail changes such as pitting (small depressions in the nails) are observed.
Radiological studies may show bone erosions and a “pencil-in-cup” deformity in the finger joints in advanced cases. Laboratory tests are typically negative for rheumatoid factor (seronegative), but acute-phase reactants (CRP, ESR) may be elevated.
Differential Diagnosis
Condition | Distinctive Features |
Rheumatoid arthritis | Symmetrical polyarthritis, positive serological tests (RF, anti-CCP), primarily affects small joints. |
Osteoarthritis | Chronic mechanical pain, no significant inflammation, degenerative changes on X-rays. |
Gout | Acute attacks, urate crystals in synovial fluid, frequently affects the big toe. |
Reactive arthritis | Asymmetric post-infectious arthritis, no psoriatic skin plaques, history of gastrointestinal or genitourinary infection. |
Ankylosing spondylitis | Primarily affects the spine, sacroiliitis, morning stiffness, typically affects young men. |
Emergency Management
In emergencies, the management of psoriatic arthritis focuses on controlling pain and inflammation. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the initial treatment to relieve joint symptoms. In more severe cases, intra-articular or systemic corticosteroids may be necessary to reduce inflammation. If there is suspicion of severe involvement or extra-articular complications such as uveitis, immediate referral to a specialist is recommended.
Definitive Treatment
Definitive treatment includes the use of disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or sulfasalazine to control disease progression and reduce inflammation. Biological agents, including tumour necrosis factor (TNF) inhibitors or interleukin inhibitors (IL-17, IL-12/23), are highly effective in refractory or severe cases.
Additionally, managing cutaneous psoriasis with topical or systemic therapies is part of the comprehensive approach. Physiotherapy is essential to maintain joint mobility and prevent long-term deformities.
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